女性腹股沟疝合并子宫圆韧带囊肿的临床特点和腹腔镜治疗策略

Clinical characteristics and laparoscopic strategy of female inguinal hernia with cyst of round ligament of uterus

目的:探讨女性腹股沟疝合并子宫圆韧带囊肿的临床特点和腹腔镜治疗策略。方法:回顾性分析2001年1月至2018年12月间,本院外科收治的63例女性腹股沟疝合并子宫圆韧带囊肿病人的临床资料,并与412例女性腹股沟疝非囊肿病人进行同期对照研究。结果:女性腹股沟疝合并子宫圆韧带囊肿以青年多见,疝类型以斜疝为主(87.3%)。术式选择腹腔镜经腹腹膜前修补术(TAPP)(93.7%)多于腹腔镜全腹膜外修补术(6.3%)。囊肿组和非囊肿组的子宫圆韧带保留率分别为34.9%和46.4%,差异无统计学意义(P=0.086)。<45岁青年女性子宫圆韧带保留率(47.1%)低于非囊肿组(89.1%),差异有统计学意义(P<0.001)。囊肿组和非囊肿组在手术时间、住院时间、术后第1天视觉模拟疼痛量表、术后血清肿、尿潴留、复发、2周内恢复非限制性活动人数上差异无统计学意义(P>0.05)。结论:女性腹股沟疝合并子宫圆韧带囊肿以青年多见。TAPP可探查并明确诊断。绝大多数子宫圆韧带囊肿都可在疝修补的同时切除。合并囊肿时保留子宫圆韧带的难度相对增加。

Objective To investigate the clinical characteristics and laparoscopic strategy of female inguinal hernia with cyst of round ligament of uterus.Methods The clinical data of 63 female patients of inguinal hernia with cyst of round ligament of uterus as cyst group admitted to our Department of Surgery,from January 2001 to December 2018 were analyzed retrospectively.The patients in cyst group were compared to contemporaneous 412 female patients of inguinal hernia without cyst as non-cyst group.Results The majority female patients of inguinal hernia with cyst of round ligament of uterus were youth with 87.3%of indirect hernia.There were 93.7%transabdominal preperitoneal(TAPP)repaire more than 6.3%total extraperitoneal repaire.The preservation rate of round ligament of uterus was 34.9%in cyst group and46.4%in non-cyst group without significant difference statistically(P=0.086).However,the preservation rate of round ligament of uterine of patients younger than 45 years in cyst group(47.1%)was less than that in non-cyst group(89.1%)and the difference was statistically significant(P<0.001).No significant difference was found between cyst group and noncyst group in operation time,hospital stay,visual analogue pain scale on the first postoperative day,postoperative seroma,urinary retention,recurrence,and the amount of patients recovery to unrestricted activities within 2 weeks(P>0.05).Conclusions Female inguinal hernia with cyst of round ligament of uterus ws more seen in young women.TAPP could be used for exploration and definite diagnosis.Most cyst of round ligament of uterus can be resected during herniorrhaphy simultaneously.The difficulty in retaining round ligament of uterus increased when the cyst is present.